Preventing Violence as a Public Health Priority

He speaks with Rob Wolf of the Center for Court Innovation about how law enforcement can benefit from partnerships with public health.

Public health expert Dr. Anthony Iton says that if you give him your address, he can tell you how long you’re likely to live. His prediction isn’t based simply on homicide rates or disease prevalence in your area. It’s based on the stress of living in neighborhoods that aren’t safe, where children avoid playgrounds for fear of stray bullets and adults stay home for fear of being assaulted.

Iton, the California Endowment’s senior vice president for Healthy Communities, was addressing an audience of police chiefs, who learned from his presentation that the community conditions that alarm public health officials can be the same that boost crime rates.

It was just one example of common ground among public health and police officials underscored by an executive session convened by Director Bernard Melekian, former Pasadena (California) Police Chief, who now leads the Office of Community Oriented Policing Services (the COPS Office) in the U.S. Department of Justice. Melekian has made it a priority to hold these types of discussions as a way to identify new ideas and approaches for more effective policing.

At the session, which was co-sponsored by The Endowment and the Center for Court Innovation, police chiefs from across the country, along with social policy experts and public health officials, explored ways to partner to reduce crime—not just as a matter of justice and public safety, but as a public health priority.

The discussion highlighted the similarities between public health officials and police. For example, both respect data and track success by the numbers, whether it’s the rate of assaults or the spread of an epidemic.

Both also use mapping to chart the “outbreaks” they seek to control. In fact, their locations often overlap, as Iton illustrated by comparing maps of violent crime hot spots to geographic concentrations of stress-related killers like heart disease, high blood pressure, and cancer.

For even though overall crime rates may generally decline, they stay higher in areas where poverty and a lack of community resources leave few positive choices. And even when crime drops, said Ron Davis, Police Chief in East Palo Alto (California), “the fear is still high. Fear may have more of an impact on stress. . .than actual crime rates.”

A public health approach to policing may promise better results in neighborhoods where youth violence is highest and life expectancy is shortest. An essential first step is sharing information.

In Milwaukee, a Homicide Review Commission brings together not only law officers investigating a case, but a range of other representatives, including community service providers, health officials, community organizers, and members of the faith community. By sharing information, participants not only crack individual cases—much as a team of physicians can diagnose and treat patients more effectively by sharing knowledge—they also identify system-wide weaknesses and recommend changes. “They know our goal is to develop prevention,
suppression, and intervention strategies,” said Dr. Mallory O’Brien, who has led the commission since supervising its launch in 2004.

Another proactive program that employs a public health model is the California Safe Communities Partnership—also known as CeaseFire—which seeks to intercept crime “carriers,” the small minority of troubled youth that can create a majority of gang violence. Working with the support of the faith-based community and employment and social service agencies, authorities and community leaders meet with gang-involved youth to encourage them—through both moral appeals and threats of serious law enforcement consequences—to stop the violence. In this way, CeaseFire works to identify and defuse potentially violent situations. In Stockton, California, the program is credited with reducing gang-related homicides by more than 75 percent, while Salinas has, in one year, seen the number of shootings cut in half and an 80 percent drop in homicides. Similar success has been seen in Boston, Chicago, Cincinnati, and Indianapolis.

“If we’re going to work together, when we work with public health, it forces us to be proactive,” said Madison (Wisconsin) Police Chief Noble Wray. But, he added, while “reactive” crime-fighting—police cracking down on perpetrators—is something policymakers will pay for, funding proactive policing can be a tough sell.

That was the issue in Milwaukee when the Homicide Review Commission was launched in 2004. “We knew the dollars were drying up,” said O’Brien, “so we wanted to focus our investments on identifiable risks.” The result: The districts where the commission operated saw a 52 percent decrease in homicides, while others saw only a 9 percent decline.

The preventive approach is “a much more effective form of policing,” said Joseph Brann, the former Hayward (California) police chief and first director of the COPS Office. “Organizations that are sincerely committed to it are able to reduce staff and crime rates. . .where people have the guts to do it.”

Another challenge lies in getting communities in crisis to trust the police and vice versa. But here, too, is where the public health approach may offer an advantage. Said Long Beach (California) Police Chief Jim McDonnell: “It takes some of the demonization away from the people who commit that behavior.”

That, he added, is the “first step in making headway with the community. The public health model changes the conversation.”